Clinical Research
Rescue stenting after failure of endovascular treatment for acute cerebral large artery occlusive infarction
Lili Dong, Hongxing Han, Hao Wang, Qiyi Zhu, Xianjun Wang, Jian Gong, Binsheng Zhang, Weihua Zhang
Published 2019-02-15
Cite as Chin J Neuromed, 2019, 18(2): 150-155. DOI: 10.3760/cma.j.issn.1671-8925.2019.02.007
Abstract
ObjectiveTo investigate the safety and efficacy of rescue stenting after failure of endovascular treatment for acute cerebral large artery occlusive infarction, and compare the differences of safety and efficacy between bridged treatment and direct endovascular treatment in acute cerebral large artery occlusive infarction.
MethodsThe clinical data of 60 patients with acute cerebral large artery occlusive infarction who underwent rescue stenting after failure of endovascular treatment in our hospital form March 2015 to March 2018 were retrospectively analyzed; 26 patients underwent bridged treatment+rescue stenting (bridged treatment group), while 34 patients underwent direct endovascular treatment+rescue stenting (direct treatment group). The recanalization degree immediately after the treatment was evaluated by Modified Thrombolysis in Cerebral Infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was performed 24 h and 5-7 d after the treatment, and modified Rankin Scale (mRS) was applied 90 d after treatment to evaluate the neurological functions. In addition, incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage (SICH) and postoperative mortality within 90 d of treatment were calculated.
Results(1) Among the 60 patients, 55 patients (91.7%) had revascularization (mTICI 2b-3) immediately after the rescue stenting. NIHSS scores before rescue stenting and NIHSS scores 24 h after rescue stenting (17.50 [15.00, 24.00) vs. 12.00 [8.25, 19.00]) showed statistically significant differences (P<0.05). Twenty-nine patients (48.3%) obtained satisfactory prognosis 90 d after rescue stenting (mRS scores≤2), 9 patients (15.0%) suffered SICH after rescue stenting, and 9 patients died (15.0%). (2) The immediate revascularization rate (92.3% vs. 91.2%), NIHSS scores 24 h and 5-7 d after surgery (12.00 [7.75, 18.00] vs. 14.50 [10.00, 22.00] and 8.00 [3.00, 12.50] vs. 10.50 [6.75, 16.75]), good prognosis rate 90 d after treatment (57.7% vs. 41.2%), postoperative SICH incidence (19.2% vs. 11.8%), and mortality (11.5% vs. 17.7%) in the bridged treatment group and direct treatment group were not significantly different (P>0.05).
ConclusionRescue stenting is safe and effective for patients with acute cerebral large artery occlusive infarction, no matter it is by bridged treatment or direct intravascular treatment; and the two methods show no significant differences in safety and efficacy
Key words:
Acute ischemic stroke; Large vessel occlusion; Endovascular treatment; Rescue stenting
Contributor Information
Lili Dong
Department of Neurology, Linyi People's Hospital, The 11th Clinical Medical School, Qingdao University, Linyi 276000, China
Hongxing Han
Hao Wang
Qiyi Zhu
Xianjun Wang
Jian Gong
Binsheng Zhang
Weihua Zhang